Solitary lymph node metastasis: treatment options

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Dennyp
Posts: 19
Joined: Thu Oct 29, 2020 9:28 pm

Re: Solitary lymph node metastasis: treatment options

Postby Dennyp » Tue Aug 31, 2021 12:49 pm

skb wrote:I met with my oncologist yesterday and he asked about my openness to strong chemo (FOLFOXIRI) for about three months and follow up with maintenance chemo. I responded that I am open to everything.

He believes that the chemo can kill cancer cells in the lymph node and will provide systemic therapy. He was not an advocate for surgery. He said that removing the lymph node is an extensive surgery with potential complications, you might feel better if you remove it but it does not guarantee that cancer does not come back. If we go for surgery, he would like me to do surgery first , recover from it and then do the chemo. He also talked about potentially adding few doses of radiation to the area but was not sure of someone would be willing to do that for me.
I am being referred to a surgeon to see what options I have. And also a radiologist.

I would like the treatment to start as soon as possible but the oncologist says I have time and I should meet with surgeon and come up with treatment plan. Overall I am uneasy and anxious



Having gone through what you are going through, I understand your anxiety. In retrospect it wasn’t that bad, it certainly wasn’t as difficult as the first surgery. Surgery does have its complications, I experienced a torn vein which a vascular surgeon had to repair. I had FOLFIRI and while more challenging that FOLFOX for me it wasn’t intolerable. The good news is you have options!
5/19 IIIC sigmoid cancer 2/25 lymph nodes positive
5/19 surgery
7/19 FOLFOX 6 months
9/20 recurrence to single lymph node
10/20 FOLFIRI 5 rounds
1/21 surgery to remove lymph node
4/21 CT NED
8/21 CT NED

catstaff
Posts: 138
Joined: Wed Mar 03, 2021 11:37 am

Re: Solitary lymph node metastasis: treatment options

Postby catstaff » Tue Aug 31, 2021 1:17 pm

FOLFOXIRI is pretty nasty, though, since it's "throw everything at it." Would bevacizumab be added, did the oncologist say?
D/H Dx 10/2019 RC age 61
Clinical T4bN2M1a (common iliac and para-aortic lymph nodes)
MSS KRAS G12D
CRT 11/19-1/20 FOLFOX 3/20-7/20
Pelvic exenteration w/LAR 8/20
ypT4bN0Mx G3 0/14 nodes LVI not seen PNI-
CEA 10/19:20, 1/20-11/20:1.6, 4.3, 3.4, 2.7, 2/21:9.0 3/21:18,40 4/21:28,19, 5/21:13.3,8.6
PET 3/21 recurrence in distal nodes, L5 vertebra, pelvis
FOLFIRI+bev 3/21-

skb
Posts: 83
Joined: Tue Mar 28, 2017 2:00 pm

Re: Solitary lymph node metastasis: treatment options

Postby skb » Tue Aug 31, 2021 9:43 pm

Hi catstaff, I do not remember if he said that bevacizumab would be added. It was a blur :(
3/21/17: Dx T3N0M0-mid rectal 4.5cm tumor
4/18 to 5/22/17: chemoradiation
6/28/17: clean biopsy
8/09/17: MRI - no evidence of tumor, no surgery, starts wait and watch
8/17/17 to 12/1/17: chemo with Folfox and oxaliplatin
5/19 expanding right lung nodule, 8mm
8/19 VATS wedge
9/19, 12/19, 4/20, 7/20, 1/21- Clean CT, MRI
7/17/21- Clean CT, MRI, CEA 15.6 !
8/02/21- Clean colonoscopy
8/24/21- PET , biopsy finds one obturator lymph node metastasis

rp1954
Posts: 1574
Joined: Mon Jun 13, 2011 1:13 am

Metastatic lymph node treatment options

Postby rp1954 » Wed Sep 01, 2021 4:43 pm

The major failing of oncologists concerns their (in)ability to totally eliminate distant, metastatic lymph nodes using 2-3 week chemo cycles, with cyclical chemo's kill - regrow - "hardening" cycle unto eventual failure. Palliative is all that can be usually done for distant LN with Folf- -ox -iri +MAb formulas without surgery - usually they buy time, despite whatever spin. Their usual biases are that this is better than the risk(s) of metastatic spread from surgery, and the big waits between surgery and chemo. Their other bias is that "theirs" is bigger and better than any other chemistry.

Then if a metastatic residue exists after surgery, patients usually miss 6-12 weeks between chemo and surgery and things can spread. A fundamental problem for normal chemo is various forms of damage vs chemo intensity, and chemo continuity.

Our plan included four special elements:
a. eliminate dead space (ahem) in the chemo-surgery-chemo cycle to less than 2-3 days (about 1.3 days actual vs 6-12 wks);
b. reduce/eliminate perioperative metastasis;
c. absolute (immuno)chemo continuity where possible (all 24 hrs, x365); AND
d. to increase chemo intensity with superior QoL, so that chemo restart was not a big ugly decision.

They were stuck on solitary nodes/sites and we were aimed for hell or high water, even if multiple sites and circulating CRC cells, as necessary. My wife has never used -iri, -oxi, MABs or cycles.
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper to almost nothing mid 2018, mostly IV C

User avatar
dianetavegia
Posts: 2728
Joined: Sat May 16, 2009 8:47 pm
Facebook Username: Diane Weldy Tavegia
Location: Villa Rica, Georgia

Re: Solitary lymph node metastasis: treatment options

Postby dianetavegia » Thu Sep 02, 2021 8:47 am

May I remind you that oncologists are trained to treat cancers with chemo (poisons) and surgeons remove said cancer. Surgery is the gold standard for cure.

A spread four years out is a good sign. I'd suggest the cells were there at your Stage III dx but that your cancer sounds like a very slow growing variety.

I had a solitary, smaller than a dime met on the back of my liver 3 years post my Stage III dx. My oncologist did suggest major surgery with a famous doctor out of Atlanta. I had 80% of my liver removed but no follow up radiation or chemo. That was spring 2012. No lymph nodes were involved but I had 5 out or 17 (I think) positive for microscopic cells in Jan. 2009 at my first dx.

I'm having my colonoscopy next Thursday. It's been 5 years since my last. The only polyp I ever had was the cancerous one in Jan. 2009.

Have faith and get that node removed!
Stage III cc surgery 1/7/09. 12 tx FOLFOX
Stage IV PET = 1.5cm liver met. HR 4/11/12

12 years since dx and 9 years post liver resection.
Pronounced CURED and discharged by onc

“O Lord my God, I cried out to You, And You healed me.” Psalms 30:2

skb
Posts: 83
Joined: Tue Mar 28, 2017 2:00 pm

Re: Solitary lymph node metastasis: treatment options

Postby skb » Wed Sep 15, 2021 11:54 am

catstaff wrote:Yeah, we were told they only do surgery on lymph nodes if it's a particular node that is "causing a problem." It's a more difficult surgery than one might think.

But why not SBRT? Is this node in a previous radiation field or is the intestine at risk? Radiation was very effective on my DH's retroperitoneal nodes at diagnosis.

But chemo may be very effective as well, and I would agree that there's a substantial chance of other lymph node involvement at some point.



Hi Catstaff, I stand corrected. When I met with radiation oncology team, they told me that this node falls in a previous radiation field and were nervous about proceeding with radiation. I still dont have a treatment plan, I meet with surgeon today
3/21/17: Dx T3N0M0-mid rectal 4.5cm tumor
4/18 to 5/22/17: chemoradiation
6/28/17: clean biopsy
8/09/17: MRI - no evidence of tumor, no surgery, starts wait and watch
8/17/17 to 12/1/17: chemo with Folfox and oxaliplatin
5/19 expanding right lung nodule, 8mm
8/19 VATS wedge
9/19, 12/19, 4/20, 7/20, 1/21- Clean CT, MRI
7/17/21- Clean CT, MRI, CEA 15.6 !
8/02/21- Clean colonoscopy
8/24/21- PET , biopsy finds one obturator lymph node metastasis

Cancercare
Posts: 1
Joined: Thu Sep 16, 2021 4:46 am

Re: Solitary lymph node metastasis: treatment options

Postby Cancercare » Thu Sep 16, 2021 4:59 am

Solitary lymph node (SLN) metastasis is a distinct subset of colon cancer associated with good prognosis. You might want to try Ask-A-Doc, a free service on OncoPower app. They have a panel of US Oncologists help patients manage symptoms or treatment options or virtually any questions absolutely free. It was started by an oncologist.

skb
Posts: 83
Joined: Tue Mar 28, 2017 2:00 pm

Re: Solitary lymph node metastasis: treatment options

Postby skb » Thu Sep 16, 2021 8:44 am

My doctors have arrived at a consensus, a treatment plan.

Surgery to remove metastatic lymph node followed by chemo.
3/21/17: Dx T3N0M0-mid rectal 4.5cm tumor
4/18 to 5/22/17: chemoradiation
6/28/17: clean biopsy
8/09/17: MRI - no evidence of tumor, no surgery, starts wait and watch
8/17/17 to 12/1/17: chemo with Folfox and oxaliplatin
5/19 expanding right lung nodule, 8mm
8/19 VATS wedge
9/19, 12/19, 4/20, 7/20, 1/21- Clean CT, MRI
7/17/21- Clean CT, MRI, CEA 15.6 !
8/02/21- Clean colonoscopy
8/24/21- PET , biopsy finds one obturator lymph node metastasis

Dennyp
Posts: 19
Joined: Thu Oct 29, 2020 9:28 pm

Re: Solitary lymph node metastasis: treatment options

Postby Dennyp » Thu Sep 16, 2021 8:37 pm

skb wrote:My doctors have arrived at a consensus, a treatment plan.

Surgery to remove metastatic lymph node followed by chemo.


I happy to hear you have a plan, I’m sure it’s a great relief knowing what’s next. Best of luck!
5/19 IIIC sigmoid cancer 2/25 lymph nodes positive
5/19 surgery
7/19 FOLFOX 6 months
9/20 recurrence to single lymph node
10/20 FOLFIRI 5 rounds
1/21 surgery to remove lymph node
4/21 CT NED
8/21 CT NED

skb
Posts: 83
Joined: Tue Mar 28, 2017 2:00 pm

Re: Solitary lymph node metastasis: treatment options

Postby skb » Fri Sep 17, 2021 9:44 am

Cancercare wrote:Solitary lymph node (SLN) metastasis is a distinct subset of colon cancer associated with good prognosis. You might want to try Ask-A-Doc, a free service on OncoPower app. They have a panel of US Oncologists help patients manage symptoms or treatment options or virtually any questions absolutely free. It was started by an oncologist.

This is very useful information that gives me hope, thank you very much
3/21/17: Dx T3N0M0-mid rectal 4.5cm tumor
4/18 to 5/22/17: chemoradiation
6/28/17: clean biopsy
8/09/17: MRI - no evidence of tumor, no surgery, starts wait and watch
8/17/17 to 12/1/17: chemo with Folfox and oxaliplatin
5/19 expanding right lung nodule, 8mm
8/19 VATS wedge
9/19, 12/19, 4/20, 7/20, 1/21- Clean CT, MRI
7/17/21- Clean CT, MRI, CEA 15.6 !
8/02/21- Clean colonoscopy
8/24/21- PET , biopsy finds one obturator lymph node metastasis


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